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Publication numberUS4568543 A
Publication typeGrant
Application numberUS 06/669,462
Publication dateFeb 4, 1986
Filing dateNov 8, 1984
Priority dateOct 8, 1982
Fee statusPaid
Also published asCA1217717A, CA1217717A1, DE106812T1, DE3380166D1, EP0106812A2, EP0106812A3, EP0106812B1
Publication number06669462, 669462, US 4568543 A, US 4568543A, US-A-4568543, US4568543 A, US4568543A
InventorsFrancesco Borrelli, Francesco Antonetti
Original AssigneeIstituto Farmacologico Serono S.P.A.
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Pharmaceutical composition containing a fibrinolytic agent and a diffusion factor, useful for the treatment of myocardial infarction
US 4568543 A
The association of a fibrinolytic agent and of a diffusion factor has been shown very useful in the treatment of myocardial infarction. It has been shown that it is very useful to administer urokinase and hyaluronidase in the quantity ratio of at least 8 to 1, the quantity of each compound being expressed in the appropriate international units.
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We claim:
1. A pharmaceutical composition for the treatment of myocardial infarction containing therapeutically effective quantities of urokinase and hyaluronidase in which the urokinase and hyaluronidase are present in a ratio, expressed in international units, of at least 8:1.
2. The pharmaceutical composition of claim 1, wherein said ratio is 16:1.
3. The pharmaceutical composition of claim 1 containing 40,000 International Units of urokinase and 2,500 International Units of hyaluronidase.
4. The pharmaceutical composition of claim 1 in a lyophilized form in ampoules for intravenous use.
5. A method of treating myocardial infarction which comprises administering a therapeutically effective quantity of the composition of claim 1.
6. A method of treating myocardial infarction which comprises administering a therapeutically effective quantity of the composition of claim 3.
7. A method of treating myocardial infarction which comprises administering a therapeutically effective quantity of the composition of claim 4.

This is a continuation-in-part of application Ser. No. 538,196, filed Oct. 3, 1983, now abandoned.

The term "myocardial infarction" describes the irreversible damaging of the cells as well as the necrosis occurring as a consequence of a total or important reduction of the coronary flow feeding some areas of the cardiac muscle; moreover, it may be a consequence of an insufficient increase of the coronary flow with reference to an increased requirement of oxygen, as may happen under some conditions of stress.

In almost all cases of persons suffering an acute and/or previous myocardial infarction, one finds in a more or less evident size, a restriction of the inside diameter of the coronary artery as a result of coronary arteriosclerosis or of some other causes.

An exhaustive treatment of the factors involved in cases of myocardial infarction, and of the therapeutic means being used today for it's care, it's prevention, and the reduction of the consequent irreversible damage to the cardiac muscle, may be found in a recent review by J. T. Willerson and L. M. Buja entitled "Causes and Course of the Acute Myocardial Infarction" published in The American Journal of Medicine, in December 1980, volume 69, pages 902-914. This review article discusses all current knowledge about the treatment and prevention of myocardial infarction, and represents an exhaustive description of the state of the art; it must therefore be considered incorporated as a reference within the instant text. The importance of coronary thrombosis in the genesis of acute myocardial infarction has been and is still subject to discussion. However, supported by the above-mentioned theoretical base, many authors have experimented successfully with a treatment by means of urokinase given as an intravenous infusion in the care of primary acute myocardial infarction. The usefulness of thrombolytical infarction treatment in its acute stage is still a controversial matter (Lancet, 4 October 1975, pp 624-626).

It has been shown recently that streptokinase administered through coronary infusion to some patients suffering myocardial infarction has been successful by causing the re-channeling of the obstructed coronary arteries. However, several secondary effects, such as arrhythmia, have been observed after the intracoronaric administration of streptokinase.

Hyaluronidase, one of the first agents indicated to change and to improve the consequences of coronary artery obstruction, does clearly reduce the extent of the experimentally induced necrosis. Such activity by hyaluronidase has been considered the result of three main mechanisms: the improved supply of nutritional substances to the myocardium; the increased washout of harmful metabolic substances, and the increased collateral hematic flow to the area with a reduced flow of blood.

A purpose of the instant invention is to supply a new preparation for the therapeutic use shown to be of particular advantage in the treatment of myocardial infarction.

Other purposes of the instant invention shall become evident from the following description.

The above-mentioned purposes are obtained by means of a composition containing a fibrinolytic agent, such as urokinase, streptokinase, etc. and moreover a diffusion-promoting agent, such as hyaluronidase.

The protective effect of the composition has been evaluated in an experimental myocardial infarction induced in the rat by means of isoproterenol. In this model, the myocardial lesions are the consequence of aggregation of the platelets within the coronary arteries, all caused by the catecholamines.

The physiologic and pathologic variations in the rats during the acute steps of myocardial necrosis and the reinstatement, are similar to those found in patients, for instance, modifications in the serum values of enzymes, lipids, catecholamines, and steroids, and electrocardiographic alterations.

The experments were carried out on Sprague-Dawley rats whose weight was 225 to 260 grams.

Myocardial infarction was induced by subcutaneous administration of two doses of 85 mg/kg in a volume of 1 ml/kg isoproterenol chlorhydrate with a time interval of 24 hours. Thirty minutes after the first injection of isoproterenol, the animals were treated at random according to the following schedule:

Group 1: Physiologic solution (NaCl 0.9%)

Group 2: Hyaluronidase, 1250 I.U./kg

Group 3: Hyaluronidase, 2500 I.U./kg

Group 4: Hyaluronidase, 3750 I.U./kg

Group 5: Urokinase 20,000 I.U./kg

Group 6: Urokinase, 40,000 I.U./kg

Group 7: Urokinase, 60,000 I.U./kg

Group 8: Hyaluronidase 2,500 I.U./kg+ Urokinase 20,000 I.U./kg

Group 9: hyaluronidase 2,500 I.U./kg+ Urokinase 40,000 I.U./kg

A tenth group, which did not receive isoproterenol but which was treated with a normal physiological solution (NaCl 0.9%) was used as a control test group.

Treatments were repeated six hours after the first administration of isoproterenol and again immediately after the second injection of isoproterenol.

All treatments were performed by slow intravenous infusion (0.8 ml/hour) into one of the tail veins.

The drugs were carried in a physiological solution (NaCl 0.9%). A solution containing both urokinase and hyaluronidase was injected into Groups 8 and 9. Six hours after the second injection of isoproterenol, two blood samples from the abdominal aorta were taken from each ether-anesthetized animal. One sample, placed in a plastic test tube containing sodium EDTA, was used to determine the plasmatic levels of the following enzymes: cardiac isoenzyme of lactic dehydrogenase (LDH), glutamic oxalacetic transaminase (GOT) and creatine phosphokinase (CPK). The second sample was placed in a plastic test tube containing sodium EDTA and acetylsalicylic acid (250 ug/ml blood) and was used for determination of plasmatic thromboxane B2 (TXB2) by means of radioimmunoassay.

Immediately after sampling, all animals were sacrificed, the hearts quickly removed and rinsed in a physiologic solution and then carefully examined to ascertain the extent of the necrotic areas. This examination was carried out using the 5 point scoring system proposed by G. Rona et al (AMA Arch Pathol 67:443-445, 1959).

The results of the different treatments on the plasmatic levels of CPK, GOT, and LDH are summarized in Table 1.

The administration of isoproterenol causes an increase in the values of CPK, GOT and LDH, respectively, to 92.3, 96.1, and 126.9 I.U. per liter in comparison to the corresponding normal waves.

The administration of hyaluronidase, independent of dose, causes a statistically significant reduction of the plasmatic levels of GOT and LDH, which levels were increased by actions of the isoproterenol. Treatment with urokinase at the doses indicated showed a non-statistically significant inhibition of the levels of the three enzymes (see Table 1).

The simultaneous administration of hyaluronidase (2,500 IU/kg) and urokinase (20,000 I.U./kg) inhibits activity of the plasmatic GOT and LDH action, being statistically significant and comparable in degree to that performed by hyaluronidase alone. On the contrary, when hyaluronidase (2,500 I.U./kg) is administered in association with urokinase (40,000 I.U./mg), one obtains a further, statistically significant reduction of the plasmatic enzymes to 46.3% for GOT and 40.2% for LDH.

As to the plasmatic level of CPK, a significant reduction is obtained in a similar way with all the treatments except the combination of hyaluronidase 2,500 I.U./kg with urokinase 40,000 IU/kg. This combination reduces the CPK values by 42.4% in comparison with the value for the infarcted control animals.

Table 2 shows the data for TXB2. The administration of isoproterenol causes an increase in the plasmatic TXB2 levels in the control group in comparison to normal values. Treatment with hyaluronidase alone, urokinase alone, or any combination of both together, brings the TXB2 levels back to normal values.

A reduction of the necrotic areas has been observed in all animals subjected to treatment. In particular, a reduction of 50% in necrotic areas was observed in the animals treated with the combination of hyaluronidase and urokinase (Table 3).

Finally, the survey of mortality as recorded during the experiments indicates a protective action of treatment with the combination of hyaluronidase (2,500 IU/kg) and urokinase (40,000 IU/kg). As a matter of fact, only this treatment causes a sharp reduction of the mortality incidence to only 12.5% in comparison to the control group which had a mortality level of 38.6%. The results of the various treatments on the mortality levels of rats are summarized in Table 4.

The results indicated above show that the intravenous administration of hyaluronidase together with urokinase reduces or causes some improvement in the infarction experimentally induced by isoproterenol. This observation is based principally upon the study of the plasmatic levels of CPK, GOT and LDH, upon the macroscopic evaluation of the extent of the infarction-damaged areas, and upon the mortality rate. In particular, one may see that sharply and surprisingly higher protective effects are obtained by the simultaneous administration of hyaluronidase (2,500 IU/kg) and urokinase (40,000 IU/kg), as is shown by the GOT and LDH levels, and the mortality rate.

It is important to underline that the protective effects provided by this combination are clearly higher than those exercised by its single components, even when these are used at doses much higher than in the combination.

The pharmaceutical production of the composition in accordance with the invention is not particularly difficult. When the substances are easily lyophilizable, as is the case with urokinase and hyaluronidase, that is the preferred form for reasons of stability. Some excipients may be suitably used in the composition as a part thereof, and this addition does not change in a substantial manner the basic idea, consisting of the simultaneous or consecutive administration of a fibrinolytic agent and of a diffusion factor.

Based upon the results shown above, it is clear that the compositions containing urokinase and hyaluronidase and particularly those compositions containing them in a ratio greater than 8:1 (the quantities being expressed in International Units of biologic activity of the relevant substances) are of particular advantage.

Within the scope of the present invention there are not only the pharmaceutical compositions containing both substances in one container, but also some particular forms of presentation supplying them separately and every form of actuation including and practically carrying out the abovementioned basic therapeutic idea.

                                  TABLE 1__________________________________________________________________________Effects of Hyaluronidase (HYAL), Urokinase (UK) and their combination onthe CPK, GOT and LDH plasmatic levels in isoproterenol(ISP) - induced myocardial infarction in rats.                           PLASMA LEVELS OF CARDIAC ENZYMES   No.      TREATMENTS           (mean = SE)EXPERI- of ISP    HYAL   UK            %         %          %MENTAL  ani-      (mg/kg s.c.)             (IU/kg, I.V.)                    (IU/kg, I.V.)                           CPK    inhi-                                     GOT    inhi-                                               LDH     inhi-GROUP   mals      TWICE  3 TIMES                    3 TIMES                           (U/l)  bit.                                     (U/l)  bit.                                               (U/l)   bit.__________________________________________________________________________0 Normal   24 --     --     --     35.67  2.81                                  -- 31.04  1.42                                            -- 18.13  1.30                                                       --  controls1 Infarcted   27 85     --     --     92.26  8.04                                  -- 96.14  4.67                                            -- 126.92  9.27                                                       --  controls2 HYAL I   17 85     1,250  --     *      28.5                                     **     24.9                                               N.S.    22.4                           65.93  7.04                                     72.13   8.01                                               98.54  9.123 HYAL II   18 85     2,500  --     *      33.1                                     **     27.7                                               *       26.1                           61.75  6.47                                     69.46  6.48                                               93.75  6.374 HYAL III   18 85     3,750  --     **     34.7                                     **     28.3                                               *       25.8                           60.24  6.71                                     68.92  8.31                                               94.16  6.295 UK I  17 85     --     20,000 *      32.9                                     N.S.   20.9                                               N.S.    13.9                           61.84  8.13                                     76.04  12.30                                               109.17  .sup.6 UK II 17 85     13     40,000 **     34.6                                     N.S.   22.4                                               N.S.    20.2                           60.27  6.56                                     74.54  11.15                                               101.24  9.137 UK III   16 85     --     60,000 **     35.0                                     *      22.3                                               N.S.    21.4                           59.91  7.03                                     74.68  10.92                                               99.75  10.028 HYAL II   19 85     2,500  20,000 *      31.1                                     **     31.6                                               **      27.0  +                             62.56  6.09                                     65.75  8.80                                               92.57  6.31  UK I9 HYAL II   21 85     2,500  40,000 ***    42.4                                     ***    46.3                                               ***     40.2  +                             53.13  4.20                                     51.59  4.15                                               75.86  5.94  UK II__________________________________________________________________________ *p < 0.05 **p < 0.01 ***p < 0.001 Student's "t" test (calculated vs. infarcted controls).

                                  TABLE 2__________________________________________________________________________Effects of Hyaluronidase (HYAL), Urokinase (UK) and their combineddosages on theplasmatic TXB2 elevation in rats with myocardial infarction inducedby isoproterenol.          TREATMENTS          ISP                  PLASMATIC LEVELS OF TXB2Experimental      No of          (mg/kg, s.c.)                 (IU/kg, i.v.)                        (IU/kg, i.v.)    %Group      animals          Twice  3 times                        3 times                               -x + ES   variation__________________________________________________________________________10  Normal controls      24  --     --     --     424.31  41.15                                         --1 Infarcted controls      27  85     --     --     636.04  86.75                                         +49.902 HYAL I   17  85     1,250  --     487.83  39.77                                         +14.973 HYAL II  18  85     2,500  --     478.12  47.41                                         +12.684 HYAL III 18  85     3,750  --     475.36  37.35                                         +12.035 UK I     17  85     --     20,000 461.23  46.68                                         +8.706 UK II    17  85     --     40,000 455.78  51.47                                         +7.427 UK III   16  85     --     60,000 463.15  56.17                                         +9.158 HYAL II  19  85     2,500  20,000 447.86  29.91                                         +5.55  +  UK I9 HYAL II  21  85     2,500  40,000 437.35  21.82                                         +3.07  +  UK II__________________________________________________________________________

                                  TABLE 3__________________________________________________________________________Effects of Hyaluronidase (HYAL), Urokinase (UK) and their combineddosages on the extent of the myocardialinjured areas induced by isoproterenol in rats.           TREATMENTS           ISP    HYAL   UK      EXTENT OF MYOCARDIALEXPERIMENTAL       No. of           (mg/kg, s.c.)                  (I.U./kg, i.v.)                         (I.U./kg, i.v.)                                 INJURED AREAS*GROUP       animals           TWICE  3 times                         3 times 0 1 2 3  4  mean score__________________________________________________________________________1 Infarcted controls       27  85     --     --      0 0 1 14 12 3.402 HYAL I    17  85     1,250  --      0 5 0 10 2  2.523 HYAL II   18  85     2,500  --      1 4 1 11 1  2.384 HYAL III  18  85     3,750  --      1 4 2 8  3  2.445 UK I      17  85     --     20,000  1 3 2 9  2  2.476 UK II     17  85     --     40,000  2 2 1 11 1  2.417 UK III    16  85     --     60,000  3 1 1 9  2  2.388 HYAL II   19  85     2,500  20,000  5 5 2 7  0  1.57  +  UK I9 HYAL II   21  85     2,500  40,000  7 5 2 7  0  1.42  +  UK II__________________________________________________________________________ *Reported as no of animals assigned to each class of the five pointscorin system.

                                  TABLE 4__________________________________________________________________________Effects of Hyaluronidase (HYAL), Urokinase (UK) and their combineddosages on themortality rate induced by the injection of isoproterenol (ISP) in rats.              TREATMENTS       ISP    HYAL   UK     MORTALITY RATEEXPERIMENTAL       (mg/kg, s.c.)              (IU/kg, i.v.)                     (IU/kg, i.v.)                            No. Survivors/                                    PercentgeGROUP       TWICE  3 times                     3 times                            total No.                                    Mortality__________________________________________________________________________10  Normal controls       --     --     --     24/24   01 Infarcted controls       85     --     --     27/44   38.62 HYAL I    85     1,250  --     17/24   29.13 HYAL II   85     2,500  --     18/24   25.04 HYAL III  85     3,750  --     18/24   25.05 UK I      85     --     20,000 17/24   29.16 UK II     85     --     40,000 17/24   29.17 UK III    85     --     60,000 16/24   33.38 HYAL II   85     2,500  20,000 19/24   20.8  +  UK I9 HYAL II   85     2,500  40,000 21/24   12.5  +  UK II__________________________________________________________________________
Non-Patent Citations
1 *Afonskaya et al. Chem. Abst., vol. 88, (1978), p. 20142t.
2Afonskaya et al.-Chem. Abst., vol. 88, (1978), p. 20142t.
3 *Hiemeyer et al. Chem. Abst., vol. 70, (1969), p. 105,084d.
4Hiemeyer et al.-Chem. Abst., vol. 70, (1969), p. 105,084d.
5 *Hofmann et al. Chem. Abst., vol. 93, (1980), p. 107,011b.
6Hofmann et al.-Chem. Abst., vol. 93, (1980), p. 107,011b.
Referenced by
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US5279824 *Nov 9, 1992Jan 18, 1994Merck Patent GmbhPharmaceutical formulation containing heparin and endo-beta-glucuronidase, useful for the treatment of thrombosis
US5900422 *Dec 22, 1995May 4, 1999Smithkline Beecham CorporationFibrinogen receptor antagonists
US6127359 *May 14, 1999Oct 3, 2000Smithkline Beecham CorporationBicyclic fibrinogen antagonists
US6296847 *Nov 17, 1993Oct 2, 2001Immunolytics, Inc.Composition for treating benign prostatic hypertrophy
US7807618Mar 11, 2003Oct 5, 2010The Board Of Regents Of The University Of Texas SystemMethods and compositions for delivering enzymes and nucleic acid molecules to brain, bone and other tissues
US20030215432 *Mar 11, 2003Nov 20, 2003Reuben MatalonMethods and compositions for delivering enzymes and nucleic acid molecules to brain, bone, and other tissues
US20070258945 *Apr 5, 2007Nov 8, 2007Northwestern UniversityG-GSF therapy as an adjunct to reperfusion therapy in the treatment of acute myocardial infarction
EP0425212A2Oct 22, 1990May 2, 1991Smithkline Beecham CorporationCyclic anti-aggregatory peptides
U.S. Classification424/94.62, 424/94.63
International ClassificationA61K38/54, A61K38/49, A61P7/02, A61K38/46, A61K38/43, A61K38/16
Cooperative ClassificationA61K38/166, A61K38/49
European ClassificationA61K38/16B1, A61K38/54, A61K38/49
Legal Events
Nov 8, 1984ASAssignment
Effective date: 19841031
Aug 4, 1989FPAYFee payment
Year of fee payment: 4
Jul 21, 1993FPAYFee payment
Year of fee payment: 8
Jul 24, 1997FPAYFee payment
Year of fee payment: 12